New CMS code for 600-mg dose of COVID-19 preventative Evusheld     

The Centers for Medicare & Medicaid Services (CMS) has created a new HCPCS product code, Q0221, for the 600-mg dose of Evusheld, a COVID-19 pre-exposure prophylaxis (PrEP) medication. Evusheld is a monoclonal antibody injection for patients who are unable to receive a COVID-19 vaccine for medical reasons or whose immune systems may not respond robustly to COVID-19 vaccination. Here’s the CMS description:

Q0221 — Injection, tixagevimab and cilgavimab, for the pre-exposure prophylaxis only, for certain adults and pediatric individuals (12 years of age and older weighing at least 40kg) with no known sars-cov-2 exposure, who either have moderate to severely compromised immune systems or for whom vaccination with any available covid-19 vaccine is not recommended due to a history of severe adverse reaction to a covid-19 vaccine(s) and/or covid-19 vaccine component(s), 600 mg.

The code is retroactive to Feb. 24, the date the Food and Drug Administration updated its Evusheld dosing recommendations to account for Omicron subvariants. The code for the previously-recommended 300-mg dose, Q0220, remains in effect and can be used for “catch-up” doses.

Evusheld is an important resource for organ transplant patients, patients undergoing some cancer treatments, and patients who take certain medications for autoimmune diseases such as rheumatoid arthritis. But access to the medication has so far been hampered by supply and distribution issues.

Visit the CMS COVID-19 Monoclonal Antibodies Toolkit and COVID-19 Vaccines and Monoclonal Antibodies webpage for more information.  

— Kent Moore, senior strategist for physician payment, American Academy of Family Physicians

Posted on March 25, 2022, by Kent Moore